Constipation-Diarrhea and bleeding

Hey there, I am a 19 year old female who has suffered stomach problems for as long as I can remember. I've even been to the ER as a child for the pain (they just said not a appendicitis go home).

I have many other symptoms but the ones i'm asking about are fluctuation between constipation and painful bowel movements causing rectal bleeding and diarrhea. I have been to a Gastro doctor and had a colonoscopy and endoscopy which were normal this was about 2 years ago. At that time I would have a bowel movement and find a few drops of fresh blood on the toilet paper. Currently when I am in my constipation cycle I have entire gushes of red blood in the toilet and the paper. From what I can tell the bleeding is NOT in the actual stool so it's probably hemorrhoids or an anal fissure. I am being tested for Lupus which I think is causing the other symptoms and possibly this as well, but I want to know more about this particular problem.

1. How much blood is worrisome?
2. Whats the difference between an Anal Fissure and a Hemorrhoid (I asked the Dr. to check for these when he did the colonoscopy but he never said anything. He was a very bad dr though, no lies completely botched my labwork and diagnosed me twice with things that never tested positive)
3. And do you experience this back and forth rotation (the Gastro said it wasn't IBS either, although my father has IBS, but apparently there are some markers for it that I am missing) My constipation cycle can last a week to a couple weeks and then the diarrhea can last 1 day to a week.

Thanks
Spunky

I actually have had the opposite problem on my menstrual cycle, I often become very constipated. There are times it's the other way around but what I'm saying is the constipation-diarrhea cycle doesn't change on my cycle.

I have been on the pill to control my cycle with the idea that i'd only have a period every 3 months, so until recently it's been about every 6-8 weeks. I have decided that I want to try having a regular cycle again as I haven't been off birth control since I was 12.

I know that the problem I'm experiencing with bleeding is very painful, it feels like a tear when I have any kind of 'normal' stool. By that I mean I'm either experiencing pain and bleeding from normal to very hard stools, or i'm experiencing burning and acid feeling from diarrhea (lately there has still be some blood during this phase as well). My problem is that this bleeding isn't going away, it's gradually getting worse over some years.

I am never regular in my bowel movements, it just doesn't happen. I hear twice a day is normalish, and i'm either every other day or every hour.

Hi Spunky- Anal fissures are common with constipation. To answer your questions:
1) The amount of blood is not as much of a concern as the source of the blood. Anal fissures will bleed. Otherwise, if the blood is coming from an internal source then you need to find out what the cause is.

2) Hemorrhoids are swollen and inflamed veins. This can cause the skin to erode and therefore you will have blood. Here is a good article on hemorroids http://www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/definition/con-20029852. Anal fissures are tears in the rectum area. They are very painful. My daughter gets them from her constipation.

3) I don't know about the back and forth, perhaps others can weigh in. My daughter has always been constipated.

You need to find a GI that takes you seriously. You may need another colonoscopy/endoscopy, or imaging of your intestines. You may also need more tests. You deserve to get answers about what is going on with you, even if the answers are that they have done every available test/procedure and nothing emerges as the source. Then a doctor needs to make you as comfortable as possible with any medications that you are comfortable taking.

In the meantime try to manage your symptoms. Miralax is great for constipation, and if you take regularly while constipated it should alleviate anal fissures/hemorrhoids if you have them. I buy generic at Costco and save a lot of money.

Also, just because you are 'missing markers for IBS' doesn't mean that you don't have it. People have very different markers and symptoms. I don't trust that doctor at all! Get a new one.

Keep digging and pushing until you have answers that you are comfortable with.

Hope this helps and big hugs!

I have used miralax before (doctors orders) and that was a while ago. I used it recently for some constipation that wasn't going away quite like normal and ended up with diarrhea for almost an entire week from 2 doses. My problem is the constant shifting between the two. I can't take miralax to regulate it because sometimes it doesn't need softening it needs the opposite. I wish there was a way to regulate it better so that it is a 3-4. I would say mine are either a 2 or a 5-6. Never calm. It sounds exactly like what I would expect IBS to be like , how is ibs treated? My dad has it but doesn't take anything for it that I know of.

I am in the process of seeing many doctors, a rheumatologist next and if he/she suggests it I will re visit a new Gastro but the last gastro was just such a horrible let down that I have been ignoring redoing it.

I started with miralax when trying to address similar issues and I experimented with different dosages. I found that a 1/4 dose daily did good things, but more than that would give me diarrhea. I used this method for a few months and then switched to psyllium. Psyllium bulks stool and makes it more likely that I will have a daily bowel movement, or at least every other day. I started with 1 capsule and I'm now at 4 capsules daily. This has taken me more than 2 years (I went from 1 to 3 in about a month, just added the 4th a month ago).